Friday, June 26, 2009

Antithrombotic agents and the risk of cerebral microbleeds

Antiplatelet agents, but not anticoagulants, were associated with cerebral microbleeds in this study. While that may seem surprising at first glance it actually makes sense. Intracranial microbleed is a disease of the elderly, and is related to amyloid angiopathy in the case of lobar bleeds and hypertensive or atherosclerotic small vessel disease in the case of subtentorial bleeds. Following a tiny break in a blood vessel your first defense against such hemorrhage is the platelet plug, not the coagulation proteins. Although warfarin is known to be associated with spontaneous intracranial hemorrhage this study challenges our thinking about antithrombotic therapy in the elderly.

Amyloid angiopathy and associated hemorrhage are related in a complex way to the APO E genotype.

Medscape CME here.

No comments: